| NPI | 1982908695 |
|---|---|
| Former Name | ABRAHAM THOMAS THEKKANATTU |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C0004293) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004293) |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2015-04-01 |