| NPI | 1891732046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000746A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1263) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2023-04-20 |