| NPI | 1942209184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002986A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085001335) |
| 363A00000X Physician Assistant (Licence: NC 102163) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2024-01-19 |