| NPI | 1104016617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: TN 48630) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA MD.203941) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2012-06-14 |