| NPI | 1073530697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MO R9779) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R9779) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2016-04-16 |