| NPI | 1811124357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0000X Internal Medicine Hematology (Licence: TX R4250) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 251598) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA L-241552) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2019-06-03 |