| NPI | 1538565551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007409) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601007230) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085007409) | |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2022-10-25 |