| NPI | 1861435679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-001528) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA01134) |
| 363A00000X Physician Assistant (Licence: CT 004173) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2020-09-21 |