| NPI | 1043982341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5543-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.008337) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2021-10-04 |