| NPI | 1093426280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004939A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.007943RX) |
| 363AS0400X Physician Assistant, Surgical (Licence: IN 10004939A) | |
| Enumeration Date | 2022-12-08 |
| Last Update Date | 2025-09-09 |