| NPI | 1063615151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: FL ME 115409) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX P2122) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2019-07-25 |