| NPI | 1467543686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: DC MD19909) |
| Additional Taxonomies | 207RN0300X Internal Medicine Nephrology (Licence: VA 0101048655) |
| 207RN0300X Internal Medicine Nephrology (Licence: DC MD19909) | |
| 207RN0300X Internal Medicine Nephrology (Licence: MD D0042936) | |
| 261QP2300X Clinic/Center Primary Care (Licence: DC MD19909) | |
| 302R00000X Health Maintenance Organization (Licence: DC MD19909) | |
| 302R00000X Health Maintenance Organization (Licence: VA 0101048655) | |
| 305R00000X Preferred Provider Organization (Licence: VA 0101048655) | |
| 305R00000X Preferred Provider Organization (Licence: DC MD19909) | |
| 305R00000X Preferred Provider Organization (Licence: MD D0042936) | |
| 305S00000X Point of Service (Licence: DC MD19909) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2024-10-11 |