| NPI | 1386289957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012161) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10002874A) |
| 363AS0400X Physician Assistant, Surgical (Licence: IN 99096106A) | |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2024-05-31 |