| NPI | 1518939073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-001052) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001640) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2012-05-15 |