| NPI | 1639135007 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 3916-320) | 
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD00039787) | 
| Enumeration Date | 2006-04-25 | 
| Last Update Date | 2025-10-30 |