Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 53122 | WI |
NPI | 1023250321 |
---|---|
Provider Name | Rodrigo G Valadares De Sousa |
First Address | Franklin, WI 53132 |
Second Address | Franklin, WI 53132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 31/01/2014 |