| NPI | 1013271956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.004418) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2012032511) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2024-05-09 |