| NPI | 1164752952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine Hematology & Oncology (Licence: KY 46646) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10043399) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT195043) | |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2022-07-26 |