| NPI | 1093098295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001338A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 99048634) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2021-04-13 |