| NPI | 1750585113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: FL ME109160) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301085558) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301085558) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2011-12-06 |