| NPI | 1962429803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: PA MD-034364-L) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: VA 0101023699) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2007-07-08 |