| NPI | 1952368011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: VT 0420007741) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NH 7489) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2012-02-03 |