| NPI | 1396949582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CT 045166) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 225212) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2007-07-08 |