| NPI | 1902025109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000348A) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 10000358A) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 2244) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2024-04-10 |