| NPI | 1073565917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4301069020) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.138267) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2021-01-18 |