| NPI | 1174816516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001291A) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: IN 5260-0628) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2020-11-25 |