| NPI | 1063696052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: DC MD040032) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 238405) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 238405) | |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2015-06-18 |