NPI | 1740663608 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003888A) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2796) |
363AM0700X Physician Assistant Medical (Licence: TN 2796) | |
363AS0400X Physician Assistant Surgical (Licence: TN 2796) | |
Enumeration Date | 2015-07-09 |
Last Update Date | 2023-02-09 |