| NPI | 1083957740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56824) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004625) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2024-05-13 |