| NPI | 1710596135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003307A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2022-12-06 |