| NPI | 1235119900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME0042953) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CT 15207) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2008-04-17 |