| NPI | 1174388441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 99124921A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-02-15 |
| Last Update Date | 2024-06-05 |