| NPI | 1033445093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005463) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH pending) |
| 363AS0400X Physician Assistant, Surgical (Licence: ND PAC0440) | |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2022-08-22 |