| NPI | 1164192134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010432) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003402A) |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2024-10-08 |