| NPI | 1780681635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME134520) |
| Additional Taxonomies | 174400000X Specialist (Licence: VI VI1128) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 87454) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-04-12 |