| NPI | 1518166909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35041380) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 057905) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: ND 9933) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: MO 2005013503) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2007-07-16 |