| NPI | 1760658959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: FL ME102890) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 002704) |
| 207RN0300X Internal Medicine, Nephrology (Licence: TX N1645) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2022-11-16 |