| NPI | 1427473818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005766) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 51469) |
| 363A00000X Physician Assistant (Licence: MA PA6030) | |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2024-01-17 |