| NPI | 1730225004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: VT 0420011966) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: HI MD-10388) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2019-05-09 |