| NPI | 1336401355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2943-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085005143) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2015-03-26 |