| NPI | 1083608913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10004767A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 99323) |
| 363A00000X Physician Assistant (Licence: IN 10004767A) | |
| 363A00000X Physician Assistant (Licence: AZ 2219) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2025-04-08 |