| NPI | 1154993319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4498) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.008352) |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2024-08-08 |