| NPI | 1427286244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: VA 0101248950) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101248950) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101248950) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2022-11-07 |