| NPI | 1669890448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SD 11990) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.064407) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2020-08-27 |