| NPI | 1447260369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: IL 085-000949) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: IN 10000855A) |
| 363AS0400X Physician Assistant Surgical (Licence: IN 10000855A) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2012-07-26 |