| NPI | 1790717478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MS 18377) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 18377) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: FL TRN-10588) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2012-01-10 |