| NPI | 1740381672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX N9103) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NV 11110) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-09-23 |