| NPI | 1063638989 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: TX P7457) | 
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: ND 8144) | 
| Enumeration Date | 2007-04-18 | 
| Last Update Date | 2024-12-04 |