| NPI | 1720607948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD.MD.61425001) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD.MD.61425001) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2026-07-21 |