| NPI | 1649653932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 202004455) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL TRN25978) |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2021-07-19 |