| NPI | 1639563679 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CA 171740) | 
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: IL 036.145836) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-27 | 
| Last Update Date | 2021-09-22 |