| NPI | 1861745135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 86780) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09719700) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2021-10-13 |