| NPI | 1407987829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085000615) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 102535) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2015-11-11 |