| NPI | 1992056774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001547a) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004441) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2022-09-19 |