| NPI | 1609259209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: FL ME150815) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: NY 295922) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2021-10-21 |