| NPI | 1841215100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2003001131) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085001930) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2025-10-08 |