| NPI | 1093970121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME121643) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2014-01057) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2016-12-08 |