| NPI | 1114945680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA G78258) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G78258) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2016-08-09 |