| NPI | 1053340638 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX L6561) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX L6561) | 
| Enumeration Date | 2006-07-03 | 
| Last Update Date | 2008-02-26 |