| NPI | 1669663811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OK 38015) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD437549) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2021-05-25 |