| NPI | 1538275508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 238.000044) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 238.000044) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2018-09-23 |