| NPI | 1912169905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NC 2011-00315) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 30897) |
| 207R00000X Internal Medicine (Licence: NC 2011-00315) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2023-10-24 |