| NPI | 1821483488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 103394) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 86914) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2026-03-09 |