| NPI | 1225518228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IN 10002553A) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 99088232A) |
| Enumeration Date | 2018-08-19 |
| Last Update Date | 2021-04-21 |