| NPI | 1710646880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003377A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003377) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2024-10-09 |