| NPI | 1962471276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CA G31028) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: NV 7060) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2014-07-16 |