| NPI | 1861458424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9103668) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085003348) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2021-12-10 |