| NPI | 1013231950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2017027196) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003699) |
| 363A00000X Physician Assistant (Licence: FL PA9106343) | |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2018-12-27 |