| NPI | 1114657152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 35104) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: MS 35104) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116036429) | |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-08-24 |