| NPI | 1114983871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: KY 42294) |
| Additional Taxonomies | 2085R0001X (Licence: IN 01059740A) |
| 207R00000X Internal Medicine (Licence: IN 01059740A) | |
| 2085R0001X (Licence: MI 4301081806) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2026-03-25 |