| NPI | 1689869513 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: OR MD28056)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 1999136261)  | 
| 207R00000X Internal Medicine (Licence: IL 036 116256)  | |
| Enumeration Date | 2007-09-13 | 
| Last Update Date | 2012-05-24 |