| NPI | 1508057688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: LA MD.201223) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 201223) |
| 207R00000X Internal Medicine (Licence: LA 201223) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2016-04-07 |