| NPI | 1568963551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: OK 6796) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2018-02-24 |
| Last Update Date | 2024-08-27 |