| NPI | 1346422821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 20085) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-003145) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2021-11-10 |