| NPI | 1629791843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003794A) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2022-12-20 |