| NPI | 1245561422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 0144221) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-003687) |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2014-05-22 |