| NPI | 1003268715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME156522) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 21349) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 32746R) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2023-01-30 |