| NPI | 1417100207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: WA MD60744505) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2008-0737) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM 101645666) | |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2018-05-07 |