| NPI | 1497291926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54322) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085008400) |
| Enumeration Date | 2017-01-08 |
| Last Update Date | 2025-10-15 |