| NPI | 1649369844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA G058813) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access (Licence: CA g058813) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |