| NPI | 1013938174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL GALLUP Credentialing Coordinator 315-218-0085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2018-03-17 |