| NPI | 1124137104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 60383) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: LA L#14742R) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-11-09 |