| NPI | 1134497308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002442A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007882) |
| 225500000X Specialist/Technologist (Licence: MI M242760115480) | |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2024-09-05 |