| NPI | 1235789421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002803A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 10002803A) |
| 363AM0700X Physician Assistant Medical (Licence: IN 10002803A) | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2023-03-07 |