| NPI | 1720463524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: VA 0101274011) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX U2571) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2026-08-10 |