| NPI | 1265718993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085004208) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 771523) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2024-02-01 |