| NPI | 1780039727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: KY 58602) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 29143) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2023-07-05 |