| NPI | 1780665810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: HI MD-11121) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 35-060380) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: GA 047953) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2007-07-08 |