| NPI | 1629058987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: HI 15191) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 209302) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2011-07-19 |