| NPI | 1891776662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 74589) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MA 74589) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2010-01-14 |