| NPI | 1538395942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003821A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056046) |
| 363AS0400X Physician Assistant Surgical (Licence: PA MA056046) | |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2022-11-16 |