| NPI | 1063854586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101266367) |
| Additional Taxonomies | 207RX0202X Internal Medicine, Medical Oncology (Licence: VA 0101266367) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2024-04-11 |