| NPI | 1801890314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 35063264W) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 63264) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2019-09-11 |