| NPI | 1790245819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2026-02526) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC MMD.89743) |
| 207R00000X Internal Medicine (Licence: AL 41842) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2026-07-10 |