| NPI | 1396856555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: TX G2850) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: AR C5304) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |