| NPI | 1073615324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 36301) |
| Additional Taxonomies | 207RR0500X Internal Medicine, Rheumatology (Licence: ND 10324) |
| 207RR0500X Internal Medicine, Rheumatology (Licence: NY 277958) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2021-12-15 |