| NPI | 1578978995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: FL ME168343) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.131927) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2024-07-01 |