| NPI | 1699380139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010457) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13924) |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2024-09-19 |