| NPI | 1730383449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX l6210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX L6210) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2021-12-10 |