| NPI | 1821152067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: VA 0102201636) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: WI 18229) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2024-01-19 |