| NPI | 1063687929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 69785) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: CT 69785) |
| 207RN0300X Internal Medicine, Nephrology (Licence: NY 235372) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2021-11-30 |