| NPI | 1770978900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: GA 85416) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN26087) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2020-08-11 |