| NPI | 1245229764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI 4201) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: RI 4201) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2007-07-08 |