| NPI | 1982756763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 16905) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 16905) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2010-09-27 |