| NPI | 1558503888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: TX T2514) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: VT 042.0013267) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2022-11-21 |