| NPI | 1164497699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD060508L) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME128692) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2019-10-05 |