| NPI | 1831152883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 265164) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35082919) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2012-09-17 |