| NPI | 1649765744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 57.245564) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.245564) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT222271) | |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2025-07-29 |