| NPI | 1902997646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2019-02450) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NE 316) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2021-03-11 |