Pai graduated with his MBBS from Karnatak University in 1958. He later graduated from Temple University with his Master of Health Administration.
In 1961 he returned to Manipal to become the administrator of Kasturba Hospital, the teaching hospital of KMC. After the death of his father T.M.A. Pai in 1979 he became the head of the group later took over as chancellor in due course Chancellor of Manipal University and the Chairman of the Manipal Education and Medical Group. He is also the Pro-Chancellor of Sikkim Manipal University and president of T. A. Pai Management Institute and Registrar of the Academy of General Education, Manipal.
His efforts led to Manipal University getting the status of a deemed university granted by the University Grants Commission in 1993. Manipial Education and Medical Group under his watch has led to exponential growth.
He has previously served as a member of the Executive Council of Assam University, the academic senate of Mangalore University, and the National Assessment and Accreditation Council.
In 2000, he was nominated by the Union Minister of Human Resource Development to a special six-member advisory committee to the Department of Higher Education.
In 2001, Pai set up the Manipal Foundation to run the university's philanthropic efforts.[8]
His Son is well renowned Educationist and Health Care Barron Dr. Ranjan Pai.
Pai’s contributions to education have been recognised nationally and internationally. He has received a number of awards and honours in recognition of his contribution to education, healthcare, business and community service.
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