| NPI | 1164717054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: SC 40409) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P94566) |
| Enumeration Date | 2011-06-18 |
| Last Update Date | 2018-03-17 |