| NPI | 1336591841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3066) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00355) |
| 363A00000X Physician Assistant (Licence: AR PA-1230) | |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2026-07-15 |