| NPI | 1912191545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: TX P8230) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301087250) |
| 207R00000X Internal Medicine (Licence: WI 54466) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2015-01-08 |