| NPI | 1437274511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 238.000407) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 126435) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 126435) | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: MN F01522) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2018-10-15 |