| NPI | 1285344986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-1163) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 5312) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2023-05-03 |