| NPI | 1528614484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012221) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085007204) |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2024-03-13 |