| NPI | 1164730289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10004676A) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9108763) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2025-01-14 |