| NPI | 1730260761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD00039078) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA 39078) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NE 21405) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 9801542) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: MD 48268) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2010-11-03 |