| NPI | 1912326554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NC 2022-01395) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 35.142252) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2022-10-31 |