| NPI | 1497016968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 007725) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004358) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2015-09-24 |