| NPI | 1659548733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX P0120) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P0120) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2012-07-04 |