| NPI | 1902328909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002766A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9110468) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2019-10-01 |