| NPI | 1578728986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME112492) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 003163) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2014-02-18 |