| NPI | 1326364787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002792A) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: KY 2621) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2019-09-24 |