| NPI | 1760505341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME92543) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME92543) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: MS 18960) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2009-11-30 |