| NPI | 1376534842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: IL 238.000002) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TX SA00195) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2021-11-09 |