| NPI | 1043705528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S8425) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: TX S8425) |
| 261QP2300X Clinic/Center, Primary Care (Licence: TX S8425) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2026-05-21 |