| NPI | 1124014923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA C 52423) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: PA MD044783L) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 17118) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35064253) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2026-02-10 |