| NPI | 1255596268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2017-01557) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57-014321) |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2021-08-10 |