| NPI | 1134111990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME104916) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35083486Q) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2018-05-10 |