| NPI | 1952612814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10001176A) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.003888) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2022-10-10 |