| NPI | 1194354845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085.008745) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003647A) |
| Enumeration Date | 2020-04-05 |
| Last Update Date | 2025-05-21 |