| NPI | 1912983206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: TX H0324) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 35.142221) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2021-06-29 |