| NPI | 1922082130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME70375) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.129742) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 67241) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2023-05-23 |