| NPI | 1609878487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000656A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 28149068A) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2018-10-30 |