| NPI | 1619192101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: VA 0101020951) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: VA 0101020951) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-07-08 |