| NPI | 1790769792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MD MD34498) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MD D34498) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: IN 01068264A) | |
| 282N00000X General Acute Care Hospital (Licence: IN 01068264A) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2023-09-20 |