NPI | 1649293838 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10022080A) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 093651) |
Enumeration Date | 2006-07-26 |
Last Update Date | 2023-04-27 |