| NPI | 1548554546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL OS14368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT014244) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2018-03-17 |