NPI | 1902282031 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: MN 63305) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT209772) |
Enumeration Date | 2015-07-30 |
Last Update Date | 2021-09-27 |