| NPI | 1508912759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CT 032784) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: NY 187338) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2007-07-08 |