| NPI | 1912042904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35-092795) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: VA 0109541140) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2011-06-28 |