| NPI | 1699372672 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004925A) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9113562) | 
| Enumeration Date | 2020-10-03 | 
| Last Update Date | 2025-08-15 |