| NPI | 1700874625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME44692) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME4692) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2010-03-02 |