| NPI | 1740363001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001368A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601004453) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2014-03-06 |