| NPI | 1124222716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 50574) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN Temp) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2014-05-29 |