| NPI | 1194755900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 27146) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: ND 12078) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2012-03-29 |