| NPI | 1154418119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MO 103770) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: IL 036-086874) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2015-11-04 |