| NPI | 1669651881 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4301106886)  | 
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY 48191)  | 
| 207RG0100X Internal Medicine, Gastroenterology (Licence: IL 036126808)  | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: HI MD-20060)  | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: OH 35.095151)  | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.013847)  | |
| Enumeration Date | 2007-10-25 | 
| Last Update Date | 2025-04-29 |