| NPI | 1649474214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME112279) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP1-0026435) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2015-04-17 |