| NPI | 1306109939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME137347) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100929) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100929) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-06-29 |