| NPI | 1609557800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: SC 5300PA) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 5099) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2025-03-05 |