| NPI | 1679770556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MN 50771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 50771) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2020-08-12 |