| NPI | 1811377955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101275481) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 591992) |
| 207RN0300X Internal Medicine, Nephrology (Licence: VA 0101275481) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2022-10-03 |