| NPI | 1770837270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: KY 49532) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CA 155620) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2019-07-30 |