| NPI | 1841093085 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004800A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2025-03-31 |
| Last Update Date | 2025-05-06 |