| NPI | 1902217888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD61119338) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 00000) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 67100-20) | |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2021-08-16 |