| NPI | 1770929614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD61203981) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX S1972) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2021-11-16 |