| NPI | 1134216930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CA 20A9189) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A9189) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2015-03-12 |