| NPI | 1194354845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003647A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085008745) |
| Enumeration Date | 2020-04-05 |
| Last Update Date | 2022-08-08 |