| NPI | 1316108970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-003467) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005286) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2024-07-18 |