| NPI | 1669025003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MO 2025029743) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.248178) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2025-07-21 |