| NPI | 1346584562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001640A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 99058761A) |
| 363A00000X Physician Assistant (Licence: MI 5601007013) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2017-04-05 |