| NPI | 1164632691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 250564) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 250564) |
| 207RN0300X Internal Medicine, Nephrology (Licence: MA 250564) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2014-01-28 |