| NPI | 1649793522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IN 10002244A) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10002244A) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2022-07-18 |