| NPI | 1548242738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085002227) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7396-23) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2023-08-03 |