| NPI | 1811124472 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 18703) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 18703) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2009-06-22 |