| NPI | 1174902761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.146254) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 62479) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2022-09-20 |