| NPI | 1952187965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10004155A) |
| Enumeration Date | 2023-09-05 |
| Last Update Date | 2024-04-17 |