| NPI | 1912055237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.099991) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 64125-20) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2022-06-13 |