| NPI | 1164734745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.146745.MIL) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101252266) |
| 207R00000X Internal Medicine (Licence: VA 0101252266) | |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2025-02-28 |