| NPI | 1114993383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9104983) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002045) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2016-12-28 |