| NPI | 1063943314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NY 320409) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: VA 0101274650) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-11-03 |