| NPI | 1467867937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085008742) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10002312A) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-10-06 |