| NPI | 1760467443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX R0379) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA G40851) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2025-10-13 |