| NPI | 1083994495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 006574) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004083) |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2012-09-25 |