| NPI | 1669301636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085012376) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10005378A) |
| Enumeration Date | 2026-05-15 |
| Last Update Date | 2026-08-13 |