| NPI | 1952988891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003510A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA2801) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2023-06-05 |