| NPI | 1912391533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 201900450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 201900450) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2024-03-21 |