| NPI | 1811055221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TN 30700) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TN MD0000030700) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2021-06-04 |