| NPI | 1528577657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.006336) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003987A) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2023-06-21 |