| NPI | 1891920195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME112737) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 64524) |
| Enumeration Date | 2009-05-16 |
| Last Update Date | 2020-08-31 |