| NPI | 1700216322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085004825) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00586200) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2023-05-24 |