| NPI | 1356907521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OH 57.253990) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD477753) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2023-07-06 |