| NPI | 1245769165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301504939) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: MN 76595) | |
| 207R00000X Internal Medicine (Licence: OH 35.135409) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4301504939) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2025-05-05 |