| NPI | 1972797892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: MI 5101009426) |
| Additional Taxonomies | 207RR0500X Internal Medicine, Rheumatology (Licence: MI 4301090701) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2025-07-31 |