| NPI | 1831441641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9112081) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004428) |
| 363A00000X Physician Assistant (Licence: IL 085-004428) | |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2024-08-30 |