| NPI | 1811557523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: PR 35528-R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 14721-I) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 34505R) | |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2022-07-10 |