| NPI | 1114911971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 2974) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IL 085000452) |
| 363A00000X Physician Assistant (Licence: TN 2974) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085000452) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2022-08-24 |