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 |