| NPI | 1881062370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10003901A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0005880) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2023-05-16 |