| NPI | 1548619190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002053A) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: IN 1133601) |
| Enumeration Date | 2016-06-05 |
| Last Update Date | 2024-01-19 |