| NPI | 1063770592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: FL ME136451) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 19644) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2018-10-31 |