| NPI | 1003040981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: AZ 42590) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 251288) |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2011-09-28 |