| NPI | 1104111509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CT 61070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 55200) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: MN 55200) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2018-08-22 |