| NPI | 1841453545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 42516) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 42516) |
| 208000000X Pediatrics (Licence: KY 42516) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2012-06-15 |