| NPI | 1710265681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX R6688) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO2872) |
| 207R00000X Internal Medicine (Licence: FL OS12694) | |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2022-02-18 |