| NPI | 1346345642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2433-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-003672) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2026-07-30 |