| NPI | 1700991858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601003040) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 363A00000X) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2014-04-29 |