| NPI | 1043499478 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA A71224) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A71224) | 
| Enumeration Date | 2007-11-02 | 
| Last Update Date | 2012-01-13 |