| NPI | 1215548540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010170) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2022004072) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2024-11-27 |