| NPI | 1598151359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM PA2021-0044) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085005895) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2021-09-07 |