| NPI | 1770961617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: TN 63357) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R7740) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301106990) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2021-06-30 |