| NPI | 1063443992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 52756) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002101) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-07-08 |