| NPI | 1952162984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004392A) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: IN 10004392A) |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2025-07-28 |