| NPI | 1528332939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: IN 10001751A) | |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2021-07-29 |