| NPI | 1154421576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA A112746) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 241719) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2013-10-01 |