| NPI | 1801895248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NY 229556) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 229556) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2015-04-30 |