| NPI | 1093820045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4644) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-001720) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2023-03-31 |