| NPI | 1760766356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RR0500X Internal Medicine, Rheumatology (Licence: FL ME122420) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 36724) |
| 207R00000X Internal Medicine (Licence: OH 57019626) | |
| 207R00000X Internal Medicine (Licence: FL ME122420) | |
| Enumeration Date | 2011-10-01 |
| Last Update Date | 2021-08-09 |