| NPI | 1003236787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: NC 2017-00882) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 201812) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2020-05-14 |