| NPI | 1861952145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 71514) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 1501) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-06-23 |