| NPI | 1245792845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: NE 32718) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2026-06-11 |