| NPI | 1750735700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: WA MD61181685) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RN0300X Internal Medicine, Nephrology (Licence: OR MD204924) | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2026-03-04 |