| NPI | 1639664063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC RTL22-1070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101272079) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-07-05 |