| NPI | 1134779465 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: TX V5025) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V5025) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-18 | 
| Last Update Date | 2025-07-09 |