| NPI | 1275063893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2023-01438) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220068) |
| 207R00000X Internal Medicine (Licence: MA 272634) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT220068) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 272634) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-11-19 |