| NPI | 1972555183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 211062) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CT 044174) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2012-07-23 |