| NPI | 1205966256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: KY 41998) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R1271) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2012-03-26 |