| NPI | 1588649255 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: AL 11294)  | 
| Additional Taxonomies | 174400000X Specialist (Licence: AL 11294)  | 
| Enumeration Date | 2005-12-14 | 
| Last Update Date | 2015-03-16 |