| NPI | 1679950620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 293214) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A143843) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2020-03-24 |