| NPI | 1023253648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007265) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005535) |
| 363A00000X Physician Assistant (Licence: PA MA063310) | |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2023-01-30 |