| NPI | 1366691743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: VA 0101249970) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101249970) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.133395) | |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2022-09-28 |