| NPI | 1871584979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: VA 0101042422) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: WV 11832) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2025-03-24 |