| 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 |