NPI | 1174098214 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 100026494A) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
363AS0400X Physician Assistant, Surgical | |
Enumeration Date | 2018-10-04 |
Last Update Date | 2025-06-02 |