| NPI | 1811916612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 6031) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 21961-875) |
| 363A00000X Physician Assistant (Licence: SC 5688) | |
| 363A00000X Physician Assistant (Licence: AR PA-1113) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IN 10000417A) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2025-07-29 |