| NPI | 1164874186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NY 292328) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 756166811) |
| Enumeration Date | 2016-07-02 |
| Last Update Date | 2022-06-30 |