| NPI | 1790762086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: ND 11561) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 47691) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2022-03-08 |