| NPI | 1366706723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MN 63015) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.020693) |
| Enumeration Date | 2012-06-30 |
| Last Update Date | 2023-09-06 |