| NPI | 1811855893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085011995) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: OH 50.010009RX) |
| Enumeration Date | 2026-01-09 |
| Last Update Date | 2026-02-12 |