| NPI | 1629498787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: LA 322077) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 322077) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2020-09-01 |