| NPI | 1235346701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 385-000818) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10000695 A) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2007-07-08 |