| NPI | 1730179151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RR0500X Internal Medicine, Rheumatology (Licence: TX J2483) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX TX J2483) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2025-08-07 |