| NPI | 1649557851 |
|---|---|
| Former Name | RAVISANKAR ELAYIDATHINGAL |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 292434) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX permit) |
| 207R00000X Internal Medicine (Licence: VA 0101252069) | |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2022-08-10 |