| NPI | 1912159252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 1002436A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IN 1022436a) | |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2024-04-23 |