| NPI | 1619996774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NJ MA06159800) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 182511) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2011-03-15 |