| NPI | 1871890129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085003977) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001402A) |
| Enumeration Date | 2011-02-23 |
| Last Update Date | 2022-04-05 |