| NPI | 1740749779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601013253) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.006989) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-11-21 |