| NPI | 1669632683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NM MD2026-0470) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM RS2009-0340) |
| 208600000X Surgery (Licence: OK 26390) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208600000X Surgery (Licence: IL 036.129197) | |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2026-08-10 |