| NPI | 1912512476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003093A) |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2023-01-19 |