| NPI | 1477355907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116041667) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MDCE.ML.61684713) |
| Enumeration Date | 2025-03-25 |
| Last Update Date | 2026-05-07 |