| NPI | 1225404775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 50813) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY FL045) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: KY FL045) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.pending) | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2024-05-14 |