| NPI | 1710276969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 122346) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: NY 122346) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2011-09-14 |