| NPI | 1548640774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4424-023) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085005469) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2024-01-07 |