| NPI | 1811124886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MO 2011004665) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 2536871) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: IN 01066972A) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2011-02-23 |