| NPI | 1578799508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OK 29113) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT194628) |
| 207R00000X Internal Medicine (Licence: OK 29113) | |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2015-05-28 |