| NPI | 1528392628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9118211) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003721) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2024-02-09 |