| NPI | 1083876288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 31095) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL31095) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: OH 35123122) | |
| Enumeration Date | 2008-06-28 |
| Last Update Date | 2020-10-23 |