| NPI | 1588234033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5284) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.2066) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2023-03-31 |