| NPI | 1083253306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 099619) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.007911) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2025-07-01 |