| 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 |