| NPI | 1518266725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004026A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1963) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2023-09-29 |