| NPI | 1568299253 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 01082531A) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10004620A) | 
| 363A00000X Physician Assistant | |
| Enumeration Date | 2024-09-17 | 
| Last Update Date | 2025-09-05 |