| NPI | 1689109126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX W0165) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 76978) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD61064581) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 76978) | |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2025-07-29 |