| NPI | 1457589426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WV 29747) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 44952) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 44952) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME123491) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME123491) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2021-11-18 |