| NPI | 1639280555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 32767) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MA 32767) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-01-10 |