| NPI | 1184056624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085004742) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10002720A) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2025-02-07 |