| NPI | 1144357740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001021A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY 798) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2025-05-16 |