| NPI | 1629045505 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 20816) | 
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 20816) | 
| Enumeration Date | 2006-03-01 | 
| Last Update Date | 2020-11-11 |