| NPI | 1356655732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: PR 20738) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 20738) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2016-05-19 |