| NPI | 1487609855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME84340) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX K4109) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2008-09-20 |