| NPI | 1588765010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10002805A) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085001943) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-10-06 |