| NPI | 1528470341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13315) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-005039) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2020-05-27 |