| NPI | 1962923177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: KY 56068) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: MO 2020011726) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-07-21 |