| NPI | 1760562094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME44114) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0044114) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-10-20 |