| NPI | 1760796395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 4038) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 4038) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085003810) | |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 4038) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085003810) | |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2023-04-20 |