| NPI | 1861697740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: SC 82452) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD039917) |
| 207R00000X Internal Medicine (Licence: VA 0101252282) | |
| 207R00000X Internal Medicine (Licence: TN 46491) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: GA 72729) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2024-04-15 |