| NPI | 1952665804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: WI 68025-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN17319) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2023-08-02 |