| NPI | 1750472817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: WV 20783) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 20783) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2013-02-21 |