| NPI | 1902637069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085011021) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10004716A) |
| Enumeration Date | 2024-08-12 |
| Last Update Date | 2025-01-24 |