| NPI | 1447540943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01075046A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 85603) |
| 208M00000X Hospitalist (Licence: IN 01075046A) | |
| 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-80875) | |
| 207Q00000X Family Medicine (Licence: MN 57710) | |
| 207Q00000X Family Medicine (Licence: WI 62374-20) | |
| 207Q00000X Family Medicine (Licence: IA MD-48155) | |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2026-05-04 |