| NPI | 1124276761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: GA 074361) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT193678) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2015-11-18 |