| NPI | 1962898007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35C.002547) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME155332) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME155332) | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2025-10-02 |