| NPI | 1417105123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: PA MD452034) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RG0100X Internal Medicine Gastroenterology (Licence: CA A124237) | |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2015-03-12 |