| NPI | 1285745711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 85-002763) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 085-002763) |
| 363A00000X Physician Assistant (Licence: MO 2008025807) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-11-15 |