| NPI | 1376518522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 18166) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CO 18166) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2008-12-31 |