| NPI | 1700038346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2069) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 99034373A) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2025-05-28 |