| NPI | 1043348717 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000772A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085001616) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2022-01-18 |