| NPI | 1700131125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: WA MD61032416) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: RI MD15199) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2021-03-01 |