| NPI | 1871507343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA C150072) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 095719) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2026-02-04 |