| NPI | 1801874664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 3873-23) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 8500535) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2016-10-26 |