| NPI | 1831211069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: CO 45995) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CO 45995) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2014-03-06 |