| NPI | 1497908388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 030691) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085.003347) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2023-12-15 |