NPI | 1124472782 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NY 299752) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 68276) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-04-20 |
Last Update Date | 2023-06-20 |