| NPI | 1750492096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 29624) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CO 42598) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-12-20 |