| NPI | 1699038653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.150000) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NM MD2019-0605) | |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2024-03-20 |