| NPI | 1962822197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RR0500X Internal Medicine, Rheumatology (Licence: VA 0101259222) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RR0500X Internal Medicine, Rheumatology (Licence: WV 28854) | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2020-12-06 |