| NPI | 1306278288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: PA MD466440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301102659) |
| 282NC0060X General Acute Care Hospital, Critical Access (Licence: DC MD044161) | |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2019-09-11 |