| NPI | 1003255498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 177139) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 56061) |
| 207R00000X Internal Medicine (Licence: IN 01083839) | |
| 207R00000X Internal Medicine (Licence: IN 01083839A) | |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2026-01-12 |