| NPI | 1972795664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3713) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: IN 31004476A) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2025-05-01 |