| NPI | 1083148969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD61079382) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 64801) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2023-09-25 |