| NPI | 1053339408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IN 99016197A) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 10000769A) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-02-19 |