| NPI | 1235536939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002359A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2018-11-11 |