| NPI | 1245203561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CO 0053228) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA 20A11059) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2014-12-30 |