NPI | 1457741407 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003409A) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 7466) |
Enumeration Date | 2015-01-29 |
Last Update Date | 2022-06-27 |