| NPI | 1659512895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA 60082609) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 237642) |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2022-12-08 |