| NPI | 1811929029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: FL ME35398) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME35398) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-07-06 |