| NPI | 1811390370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-009723) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 51952) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2023-06-22 |