| NPI | 1518919257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085.005034) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 1070753) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2014-06-09 |