| NPI | 1780979682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME141019) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 280767) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2025-09-22 |