| NPI | 1942302880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL me0067924) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME67924) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2023-10-27 |