| NPI | 1598064941 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: DC MD040203) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| Enumeration Date | 2011-03-24 | 
| Last Update Date | 2017-09-07 |