| NPI | 1992209803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL 167682) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RX0202X Internal Medicine, Medical Oncology (Licence: FL 167682) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2026-05-27 |