| NPI | 1609215599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 85731) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 85731) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2021-06-08 |