| NPI | 1972724227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD60623525) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: MN 49892) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: OR MD158067) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2016-03-16 |