| NPI | 1255544268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NM MD2009-0489) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR MD26494) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD60086278) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2011-12-16 |