| NPI | 1700010063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4301108613) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: NE 23863) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2015-09-16 |