| NPI | 1225311665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4301109216) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57-019191) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2019-04-05 |