| NPI | 1760478564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NV 11661) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 19721) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35065820) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2014-02-14 |