| NPI | 1457936213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004033A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 64559) |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085.008218) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA 64559) | |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2025-05-28 |