| NPI | 1376679613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 42522) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP448) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207R00000X Internal Medicine (Licence: KY 42522) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2016-05-26 |