| NPI | 1780649574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 193060-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 193060-1) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2019-11-07 |