| NPI | 1346626892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001942A) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2026-06-23 |