| NPI | 1962457788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 65641) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101236908) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WY 10082A) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2023-10-18 |