| NPI | 1285862508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10001095A) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2017-08-31 |