| NPI | 1588034292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.004609) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08929) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2015-10-07 |