| NPI | 1780655589 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: OH 35070679B) | 
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: PA MD060830L) | 
| Enumeration Date | 2006-01-30 | 
| Last Update Date | 2014-04-03 |