| NPI | 1134535560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD61002980) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-10771) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2021-04-05 |