| NPI | 1902225535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MO 2019015000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2018-00820) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2019-09-23 |