| NPI | 1629423041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT 68491) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363A00000X Physician Assistant (Licence: IN 10002141A) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2018-08-23 |