| NPI | 1558532689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MA 250535) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A103081) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2014-11-20 |