| NPI | 1336116045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 1000557A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085002413) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2023-10-12 |