| NPI | 1962817767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX T3211) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.024134) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: FL TRN24096) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2021-10-19 |