| NPI | 1710237748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.004721) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001450A) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2016-06-28 |