| NPI | 1124259155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: WA MD60538102) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2009014070) |
| Enumeration Date | 2009-08-08 |
| Last Update Date | 2024-01-07 |