| NPI | 1568699304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: AZ 51688) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.097922) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2022-09-09 |