| NPI | 1225404635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005562) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001010564) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2020-10-08 |