| NPI | 1437609377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8619) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: IL 085.005958) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2022-05-31 |