| NPI | 1215956263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS9670) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL OS9670) |
| 208C00000X Colon & Rectal Surgery (Licence: FL OS9670) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2011-06-23 |