| NPI | 1053369546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085001321) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: IN 10004104A) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2025-02-10 |