| NPI | 1649244336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085003674) |
| Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: CA PA16498) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2010-02-10 |