| NPI | 1982870127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD60555376) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 127901) |
| 207R00000X Internal Medicine (Licence: OH 35.097358) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2015-07-08 |