| NPI | 1518049964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME 95164) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME95164) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2012-03-01 |