| NPI | 1033386115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 385000710) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110003884) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2025-12-08 |