| NPI | 1902036569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: FL ME140977) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: WI 63904) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC 35022) | |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2023-03-16 |