| NPI | 1699194068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL TRN24170) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD462298) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN24170) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2019-10-18 |