| NPI | 1760777320 |
|---|---|
| Other Name | NONE NONE NONE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: IL 036153634) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA 128433) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-12 |
| Last Update Date | 2022-07-21 |