| NPI | 1164457495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 176514) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 176514) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2011-12-01 |