| NPI | 1811906779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME92248) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX L4590) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 055773) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2016-09-12 |