| NPI | 1912116732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CO DR.0054784) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.010887) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2015-09-21 |