| NPI | 1962460634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: MA 80111) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 0320000487) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2010-08-18 |