| NPI | 1861632903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX p2247) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: TX P2247) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2014-05-06 |