| NPI | 1861636425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2019-01440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 113186) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: VA 0101256946) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NE 29957) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2019-07-25 |