| NPI | 1649535915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OK 43924) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX V6804) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2025-07-25 |