| NPI | 1811332315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: PR 19463) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 85161) |
| 207R00000X Internal Medicine (Licence: PR 19463) | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2025-01-13 |