| NPI | 1760481501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MA 52588) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: VT 0420007895) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: TN MD38144) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2012-02-14 |