| NPI | 1194985150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NE 25555) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2018-04-25 |