| NPI | 1407800378 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: AL 25513) | 
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: AL 00025513) | 
| Enumeration Date | 2006-05-22 | 
| Last Update Date | 2010-10-05 |