| NPI | 1104352418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002345A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 008301) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2023-05-25 |