| NPI | 1700267879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX T6952) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015017601) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 308785-01) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2022-08-01 |