| NPI | 1871678144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000975A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5601004940) |
| 363A00000X Physician Assistant (Licence: MI 5601004940) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2024-05-07 |