| NPI | 1174985568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SD 13434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 307825) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NE 34612) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: IA MD-50022) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2022-09-08 |