| NPI | 1811972219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CO 23073) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: CO 23073) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2013-04-01 |