| NPI | 1619962974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 094801) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: MI 4301083172) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2018-05-22 |