| NPI | 1154402717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME109504) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: VA 0101267484) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: FL MFC # 1615) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-09-03 |