| NPI | 1760941801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME170933) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-11-12 |