| NPI | 1679104624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009691) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085007390) |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2022-08-30 |