| NPI | 1679523070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 37760) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 19258) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2020-05-14 |