| NPI | 1013577915 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX V5964) | 
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI 4351049579) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-13 | 
| Last Update Date | 2025-06-20 |