| NPI | 1811985047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NJ 25MA04115600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25 MA04115600) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2017-04-20 |