| NPI | 1225370893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: VA 0102203981) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102203981) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA A63006405) | |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2023-12-21 |