| NPI | 1063828861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: MN 59380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 59380) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 26235) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2023-08-29 |