| NPI | 1548393747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX M3631) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX m3631) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2010-08-13 |