| NPI | 1558577452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: AL MD32456) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 225426) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2013-06-19 |