| NPI | 1942730916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: TX S3243) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 664512) |
| 208D00000X General Practice (Licence: TX S3243) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2024-01-02 |