| NPI | 1710040621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 205770) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 205770) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |