| NPI | 1750589610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX P8804) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 30026) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2014-07-22 |