| NPI | 1518557891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IN 10003589A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363A00000X Physician Assistant (Licence: IN 10003589A) | |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2024-07-12 |