| NPI | 1871148627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002873A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2022-06-03 |