| NPI | 1760478812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IN 100000724A) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9103885) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2021-02-18 |