| NPI | 1639221591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IN 10000624A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10000624A) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2015-07-10 |