| NPI | 1871024885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 287672) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: ZZ 98186) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2017-10-25 |