| NPI | 1770512774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2011-00258) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 36114942) |
| 207R00000X Internal Medicine (Licence: OH 35.088133) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2011-00258) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2016-11-29 |