| NPI | 1063550291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX N5389) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 40668) |
| 207R00000X Internal Medicine (Licence: IN 01061189AP) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 40668) | |
| 208000000X Pediatrics (Licence: KY 40668) | |
| 208000000X Pediatrics (Licence: IN 01061189AP) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2010-03-04 |