| NPI | 1407852080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 22027) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.047375) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2012-09-20 |