| NPI | 1013469246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005986) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4523-23) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2024-12-18 |