| NPI | 1528542503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95009297) |
| Additional Taxonomies | 207RN0300X Internal Medicine Nephrology (Licence: CA 95009297) |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2018-09-17 |