| NPI | 1114289873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MN 66931) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MD H84665) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT014503) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2020-07-09 |