| NPI | 1255593950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CO DR0067922) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301091809) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ 52523) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2023-12-11 |