| NPI | 1922116631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME100573) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CT 036527) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: LA MD201030) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME100573) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2016-06-15 |