| NPI | 1003814922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME65365) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0065365) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2012-10-10 |