| NPI | 1821072323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RR0500X Internal Medicine, Rheumatology (Licence: LA 023976) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: LA 023976) |
| 174400000X Specialist (Licence: LA 023976) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2018-05-18 |