| NPI | 1417657305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 11122) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 11122) |
| 363A00000X Physician Assistant (Licence: IL 085009645) | |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2025-08-27 |