| NPI | 1578902417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: RI MD16474) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 057016) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 256130) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2019-07-17 |