| NPI | 1902894025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MA 74173) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 779172) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2011-10-21 |