| NPI | 1023114832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CO 22917) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WY 8372A) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2012-06-08 |