| NPI | 1851704712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085005581) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 10001673A) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2018-08-09 |