| NPI | 1477923084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002653A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085006594) |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2024-11-07 |