| NPI | 1790345817 |
|---|---|
| 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: OH 35.152828) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351044152) | |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2025-03-19 |