| NPI | 1265666770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: KY 45409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 45409) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2020-04-10 |