| NPI | 1104118553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD60688672) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX BP10048784) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2019-08-13 |