| NPI | 1972639169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 178833) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: NY 178833) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2007-07-08 |