| NPI | 1003039124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4301077777) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301077777) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301077777) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-02-21 |