| NPI | 1669458469 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CT 037326) | 
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: AR E-6907) | 
| Enumeration Date | 2005-12-22 | 
| Last Update Date | 2011-04-13 |