| NPI | 1629132584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: WA MD00042468) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WA MD00042468) |
| 174400000X Specialist (Licence: WA MD00042468) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2021-04-21 |