| NPI | 1659987485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: WA MD61057432) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61057432) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2020-09-23 |