| NPI | 1245752211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006543) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2017022874) |
| 363AS0400X Physician Assistant, Surgical (Licence: MO 2017022874) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2026-01-06 |