NPI | 1508073057 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: CA A126290) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.009097) |
207RG0100X Internal Medicine Gastroenterology (Licence: FL ME109780) | |
Enumeration Date | 2007-05-16 |
Last Update Date | 2022-11-21 |