| NPI | 1003891623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RR0500X Internal Medicine, Rheumatology (Licence: NY 248924) |
| Additional Taxonomies | 174400000X Specialist (Licence: RI MD10106) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2012-10-01 |