| NPI | 1699038505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: SC 82015) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 82015) |
| 207R00000X Internal Medicine (Licence: KS 0438102) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2020-08-05 |