| NPI | 1518360445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-010711) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA10791) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2025-02-28 |