| NPI | 1275952541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: WA OP60645891) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP60645891) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0007356) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2020-12-02 |