| NPI | 1447205000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006293) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002697) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2023-11-27 |