| NPI | 1114142791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 120112) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RG0100X Internal Medicine Gastroenterology (Licence: NH 15657) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2013-07-02 |