| NPI | 1316147630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4301098949) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098949) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207R00000X Internal Medicine (Licence: WI 52812-020) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2023-10-20 |