| NPI | 1285208926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.008299) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 126292) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2024-08-01 |