| NPI | 1285806323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 59627) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004666) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2023-03-28 |