| NPI | 1376955047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: TX T8596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 56292) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2022-08-29 |