| NPI | 1033420898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085003761) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 2725) |
| Enumeration Date | 2010-06-27 |
| Last Update Date | 2019-09-19 |