| NPI | 1861954182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: NC 2023-01333) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV DO3131) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2026-01-13 |