| NPI | 1598954737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 002160) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003115) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2014-11-13 |