| NPI | 1316177587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: IL 036.134375) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A119014) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI L1501570) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2017-09-29 |