| NPI | 1780947754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: FL ME125338) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME125338) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN17123) | |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2022-06-14 |