| NPI | 1760640130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME117173) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 41603) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 41603) | |
| Enumeration Date | 2008-06-01 |
| Last Update Date | 2020-03-19 |