| NPI | 1477039972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: PA NIT222318) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.245707) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2021-07-06 |