| NPI | 1871973420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301107289) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: SD 14892) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2024-08-14 |