| NPI | 1912431172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NC 2023-01257) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC MD82045) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2024-08-09 |