| NPI | 1831432913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14752) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085005424) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2025-01-31 |