| NPI | 1992122063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD61681830) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 29725) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2025-07-02 |