| NPI | 1720155922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 144329) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NJ MA05628800) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2011-03-29 |