| NPI | 1699022160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine Nephrology (Licence: NC 2018-00269) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 24910) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2025-07-17 |