| NPI | 1417938077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004482A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085000553) |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085000553) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2024-10-17 |