| NPI | 1700861473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CT 021190) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 021190) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2014-01-23 |