| NPI | 1215377247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME154899) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 85072) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT204096) | |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2022-07-28 |