| NPI | 1083876197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 106197) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 61620-20) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2016-08-04 |