| NPI | 1992182604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: FL ME135871) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME135871) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN22026) | |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2021-08-02 |