| NPI | 1720345135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 080504) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: MD 52-0595110) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2018-11-21 |