| NPI | 1922106129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R6547) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MO R6547) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-07-06 |