| NPI | 1679912117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: FL ME146935) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 29336-R) |
| 207RN0300X Internal Medicine, Nephrology (Licence: NC 2019-02370) | |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2022-08-02 |