| NPI | 1790740546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CA G28907) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: CA 628907) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2010-06-22 |