| NPI | 1629276159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: GA 073151) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301085488) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2015-12-30 |