| NPI | 1962551036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 9400030) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 94-00030) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2019-10-07 |