| NPI | 1770563470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA OP61043633) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102201465) |
| 207R00000X Internal Medicine (Licence: WA op61043633) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2021-11-11 |