| NPI | 1568636991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35091931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.010881) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2023-11-06 |