| NPI | 1801088596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MD D75162) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT191250) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: DE C1-0013600) | |
| 282N00000X General Acute Care Hospital (Licence: MD D0075162) | |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2021-12-02 |