| NPI | 1467480673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 3240) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 3240) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2007-07-08 |