| NPI | 1386101608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.153102) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101271093) |
| 208D00000X General Practice (Licence: VA 0101271093) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2025-05-08 |