| NPI | 1881118925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004045A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA11420) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2023-12-29 |