| NPI | 1174739957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA TD60102809) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 57.010532) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 51193-20) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2014-04-09 |