| NPI | 1699276725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006575) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8898-23) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2026-09-03 |