| NPI | 1619382652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: AL MD.36152) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.024112) |
| Enumeration Date | 2014-06-28 |
| Last Update Date | 2018-03-17 |