| NPI | 1386190494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10003694A) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2024-05-22 |