| NPI | 1740451525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 63619) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 512) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2018-10-22 |