| NPI | 1376803635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: VA 0101255759) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101255759) |
| 208D00000X General Practice (Licence: VA 0101255759) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2020-02-06 |