| NPI | 1104821735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 24686) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 207RG0100X) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2014-08-26 |