| NPI | 1225779531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4351049456) |
| Enumeration Date | 2022-04-02 |
| Last Update Date | 2025-03-05 |