| NPI | 1417696014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003757A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2024-02-09 |