| NPI | 1124313820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA A130484) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200370) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: CA 35005) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT200370) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2020-12-16 |