| NPI | 1346655198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WI 72844-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301106214) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301106214) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2021-01-29 |