| NPI | 1609044015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 40845) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 093161) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2012-12-18 |