| NPI | 1437866720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085010212) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 10004416A) |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2024-08-21 |