| NPI | 1871081414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: NC 2021-03123) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 238237) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2024-03-12 |