| NPI | 1699778480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MO R4E46) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: KS 04-19423) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2007-07-08 |