| NPI | 1427001742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001321) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KS 0894) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2016-11-29 |