| NPI | 1114955135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA G68962) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G68962) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2014-08-21 |