| NPI | 1770876229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WY 12103A) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 48391) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2021-09-29 |