| NPI | 1811155419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2012-00912) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2012-00912) |
| 207R00000X Internal Medicine (Licence: DC 139747) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2022-01-13 |