| NPI | 1255403556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA G10040) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G10040) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2011-01-25 |