| NPI | 1568299253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 01082531A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2024-10-28 |