| NPI | 1780162156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4351047615) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.245578) |
| Enumeration Date | 2018-07-29 |
| Last Update Date | 2021-11-15 |