| NPI | 1811083025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: LA MD.10917R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 10917r) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2015-10-29 |