| 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 |