| NPI | 1962458208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001862A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002087) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2019-12-04 |