| NPI | 1780174557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV SL1352) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: UT 6069280-1204) |
| 208D00000X General Practice (Licence: NV DO2870) | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-05-10 |