| NPI | 1366971640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CT 1.067346) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 67346) |
| 207R00000X Internal Medicine (Licence: RI MD16995) | |
| 207R00000X Internal Medicine (Licence: RI LP03957) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2024-06-11 |