| NPI | 1447414420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085008235) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07505) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2021-06-11 |