| NPI | 1265747489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 269455) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 21431) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2021-11-01 |