| NPI | 1609511849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.152975) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.079740) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2025-06-18 |