| NPI | 1104189695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 35.142384) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: VA 0101262007) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-12-27 |