| NPI | 1720734171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085011609) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.007619RX) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2026-06-10 |