| NPI | 1285954669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 2622) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 2622) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV ED0104B) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2021-04-07 |