| NPI | 1942811245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003966A) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CO PA.0007212) |
| 363A00000X Physician Assistant | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2023-11-08 |