| NPI | 1366759128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME113872) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.016425) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2019-08-21 |