| NPI | 1902960560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NY 247675-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 0600003257) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2012-07-18 |