| NPI | 1831759935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4351050032) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.248187) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2022-10-10 |