| NPI | 1669480505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 20498) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2023-03523) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2024-01-03 |