| NPI | 1891795381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: PR 13234) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: FL ME100895) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2008-02-06 |