| NPI | 1790051886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2021-02139) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4301115753) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2023-03-01 |