| NPI | 1467459206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000330A) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9102834) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2020-02-13 |