| NPI | 1558749051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 308006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT208803) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2021-12-09 |