| NPI | 1245051812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 6030) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10004566A) |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2025-11-14 |