| NPI | 1770895195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001243A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003748) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2016-06-15 |