| NPI | 1154395879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2006-00971) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 00025630) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2009-07-31 |