| NPI | 1619449972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007004) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8372-23) |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2025-05-02 |