| NPI | 1548899545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007715) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009987) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-12-09 |