| NPI | 1700157450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 35.129593) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: PA MD461438) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2023-05-04 |