| NPI | 1184721656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3036) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085003171) |
| 207P00000X Emergency Medicine (Licence: IL 085-003171) | |
| 363A00000X Physician Assistant (Licence: IL 085003171) | |
| 363A00000X Physician Assistant (Licence: OH 50.004410) | |
| 363A00000X Physician Assistant (Licence: NE 2189) | |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2022-03-22 |