| NPI | 1205222882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2022-00495) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 79744) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2022-08-14 |