| NPI | 1871549535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MA 31674) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 31674) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2008-04-07 |