| NPI | 1417089418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000352A) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 001001989) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2019-12-19 |