| NPI | 1568747525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: PA MD468938) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 278494) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2019-10-18 |