| NPI | 1174726707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NE 32276) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 35.121458) |
| 207RG0100X Internal Medicine Gastroenterology (Licence: MO 2009018576) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2006016389) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.018705) | |
| Enumeration Date | 2007-06-10 |
| Last Update Date | 2020-03-27 |