| NPI | 1609873447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: VT 0420006620) |
| Additional Taxonomies | 208600000X Surgery (Licence: VT 0420006620) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2009-04-08 |