| NPI | 1811359789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CA A150714) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A150714) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2024-03-05 |