| NPI | 1548306483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA C54643) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 14565R) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2011-08-10 |