| NPI | 1588090476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 074029) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004669) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2026-03-05 |