| NPI | 1811146236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RR0500X Internal Medicine, Rheumatology (Licence: NY 245302) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access (Licence: NY 245302) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2010-03-08 |