| NPI | 1548701774 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: AL 44865) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 009532) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-20 | 
| Last Update Date | 2023-08-03 |