| NPI | 1285989269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10001418A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001418A) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2022-05-17 |