| NPI | 1760778047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2026-03144) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 34.011963) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2026-07-06 |