| NPI | 1861485724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MO MDR3G44) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MO RG344) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2026-02-16 |