| NPI | 1790433043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003872A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 99114487A) |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2026-07-02 |