| NPI | 1851354773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 109659) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: NY 109659) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2007-07-08 |