| NPI | 1013986009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1594) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 85002308) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2011-01-24 |