| NPI | 1104127679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CA A118116) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2010-11-15 |
| Last Update Date | 2022-12-02 |