| NPI | 1922397017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 52820) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX Q0307) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2018-10-01 |