| NPI | 1801056858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001065A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA19750) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2018-05-15 |