| NPI | 1114975349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME142408) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 20345) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.090758) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-12-20 |