| NPI | 1588983241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060630) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: IN 10002566A) | |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2023-03-07 |