| NPI | 1386097921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MS PA00294) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3054) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2025-03-06 |