| NPI | 1295108942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001987A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2021-06-03 |